CME Disclosure Accreditation Statement Studer Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Designation of Credit Studer Group designates this educational event for a maximum of 1 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the educational event. Disclosure Policy Quint Studer has disclosed that he does not have any relevant financial relationships with any commercial interests related to the content of this educational event.
H C A H P S - Hardwiring Your Hospital for Pay-for-Performance Success Note: These slides have been updated to reflect the April 29, 2011, CMS Released HVBP final rule, required under the Affordable Care Act and applied under Medicare s inpatient prospective payment system. Presented by: Quint Studer
Webinar Objectives How your HCAHPS results will impact your organization s reimbursement in the era of health reform Why HCAHPS results are a quality metric, not just a patient satisfaction metric How to identify the clinical outcomes you most need to focus on to improve HCAHPS results and overall quality of care Why ED performance is directly connected to HCAHPS results Why nurse communication is the single most critical composite on the HCAHPS survey Tactics you can implement right now that have a powerful positive impact on HCAHPS results and on your entire organization.
Studer Group Partners Outperform the Nation across HCAHPS Composites percentile points higher Source: The graph above shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since Jul 2008 and non-partners for each composite; updated 5.17.11 using 3Q09-2Q10 CMS data
Studer Group Partners Outpace the Nation in HCAHPS Improvements Source: The graph compares the change In one year in top box results achieved by Studer Group partners vs. non-partners. Change is from 3Q08-2Q09 to 3Q09-2Q10. The top-box is the most positive response to HCAHPS survey questions.
As Hospital s ED Percentile Ranking Increases, So Does Its HCAHPS Overall Percentile Ranking
Studer Group Partners Perform Better Than the Nation in Core Measures Heart Failure Pneumonia Healthcare-Associated Infections
Studer Group Partners Perform Better Than the Nation in Core Measures Surgical Care Improvement Heart Attack
Value Based Purchasing FY 2013 1% Base operating DRG payments 12 Core Measures (* 70% Weight) HCAHPS (* 30% Weight) Performance attainment and improvement will determine total hospital reimbursement Notes: Implementation FY 2013 (October 2012) *Value Based Purchasing Program proposed rule 1.7.11
What Will Value-Based Purchasing Mean for You? 12 Clinical Process Core Measures HCAHPS
8 Value Based Purchasing Measures H C A H P S C O M P O S I T E S A N D Q U E S T I O N S C o m p o s i t e Q u e s t i o n S u m m a r y R e s p o n s e S c a l e Nursing Communication Doctor Communication Responsiveness of Staff Pain Management Communication of Medications Discharge Information Cleanliness and Quietness of Hospital Environment Overall Rating Willingness to Recommend will continue to be reported but not included in VBP formula Nurse courtesy and respect Nurses listen carefully Nurse explanations are clear Doctor courtesy and respect Doctors listen carefully Doctor explanations are clear Did you need help in getting to bathroom? 2 Staff helped with bathroom needs Call button answered Did you need medicine for pain? 2 Pain well controlled Staff helped patient with pain Were you given any new meds? 2 Staff explained medicine Staff clearly described side effects Did you go home, someone else s home, or to another facility? 2 Staff discussed help need after discharge Written symptom/health info provided Area around room kept quiet at night Room and bathroom kept clean Hospital Rating Question Willingness to Recommend ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never Yes No (screening question) ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never Yes, No (screening question) ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never Yes, No (screening question) ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never Own home, Someone else s home, Another facility (screening question) YES, No YES, No ALWAYS, Usually, Sometimes, Never ALWAYS, Usually, Sometimes, Never 0 to 10 point scale (percent 9 and 10 reported) DEFINITELY YES, Probably Yes, Probably No, Definitely No
12 Core Quality Measures Value Based Purchasing FY 2013 Core Quality Measures Selected 2 Heart Attack (Fibrinolytic w/i 30 min s; PCI w/i 90 min s) 1 Heart Failure (Dx instruct) 2 Pneumonia (Culture in ED w/o anti; CAP immuno pt) 7 Surgical Care: Infection and Improvement Proph anti w/i1 hr of incision Proph anti selection-surg Proph anti Dx w/i 24 hrs of surg Cardiac pts-6am post-op serum glucose Beta blocker prior to arrival if received during period Recommended Venous Thromboembolism proph ordered Venous Thromboembolism proph w/i 24 hrs prior and post
What s the possible risk? Hospital Profile: 376-bed hospital 32 bed ED Inpatient Revenue: $630 million Payor mix: 45% Medicare Impact: 1% impact base operating DRG payments = $2,835,000 30%* attributed to HCAHPS performance = $850,500 potential risk 70%* attributed to Core Measure performance = $1,984,500 potential risk *Value Based Purchasing Program proposed rule 1.7.11.
Pay for Performance is Here Now* *Performance Period is July 1, 2011- March 31, 2012
VBP Proposed Calculation of Performance: Reimbursement Baseline period: July 1, 2009 March 31, 2010 Performance period: July 1, 2011 March 31, 2012 Hospital performance: the higher of an achievement score in the performance period or the improvement score as compared to the score in the baseline period To incentivize HCAHPS consistency points will be added in determining total performance.
Value-Based Purchasing - FY2014 Hospital Acquired Condition Measures (FY 2014) 1. Foreign Object Retained After Surgery 2. Air Embolism 3. Blood Incompatibility 4. Pressure Ulcer Stages III and IV 5. Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock) 6. Vascular Catheter-Associated Infections 7. Catheter-Associated Urinary Tract Infection (UTI) 8. Manifestations of Poor Glycemic Control Mortality Measures (FY 2014) 1. Mortality -30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate 2. Mortality -30-HF: Heart Failure (HF) 30-day Mortality Rate 3. Mortality -30-PN: Pneumonia (PN) 30-day Mortality Rate
Value-Based Purchasing - FY2014 Patient Safety Indicators (FY 2014) PSI 06 Iatrogenic pneumothorax, adult PSI 11 Post Operative Respiratory Failure PSI 12 Post Operative PE or DVT PSI 14 Post Operative wound dehiscence PSI 15 Accidental puncture or laceration IQI 11 Abdominal aortic aneurysm (AAA) repair mortality rate (with or without volume) IQI 19 Hip fracture mortality rate Complication/patient safety for selected indicators (composite) Mortality for selected medical conditions (composite)
HCAHPS Fundamentals and Tactics
As Hospital s ED Percentile Ranking Increases, So Does Its HCAHPS Overall Percentile Ranking
The Fundamentals: What You Must Know to Improve Your HCAHPS Results Nurse Leader Rounding AIDET SM Key Words Post Visit Calls Chapter Two: HCAHPS Handbook; The Fundamentals: What You Must Know to Improve Your HCAHPS Scores; pgs 23-44
Nursing Communication: The Most Bang for Your Buck The Nursing Communication Composite is the one most highly correlated with overall hospital rating. 1. During this hospital stay, how often did nurses treat you with courtesy and respect? 2. During this hospital stay, how often did nurses listen carefully to you? 3. During this hospital stay, how often did nurses explain things in a way you could understand?
Nurse Leader Rounding Impacts Patients Perception of Nursing Quality Increase in Percentile Ranking for HCAHPS Composite Nursing Communication Following Implementation of Nurse Leader Rounding Nursing Communication Composite - Percentile Point Improvement 10 25 SG Partners Average Percentile Rank Improvement Non-Partners Average Percentile Rank Improvement Note: When Studer Group Partners implement nurse leader rounding, they improve by an average of 25 percentile points for the Nursing Communication composite.
Leader Rounding on Patients Did a Nurse Manager Visit You During Your Stay? n= 561 n= 604 n= 601 n= 608 Tactic and Tool Implemented: Leader Rounding on Patient n= 106 n= 104 n= 96 n= 105 Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010
Rounding with Patients and Families Set expectations/validate Behavior Align Questions to Fit Desired Outcomes of the Organization Identify patient and family needs Document needs Give instructions on what to do if they do not get the care they expect Explain any post visit calls or surveys Recognize and Coach Staff
Studer Group Five Fundamentals AIDET SM A Acknowledge I D E T Introduce Duration Explanation Thank You
AIDET SM Impact on Safety and Quality Change in Percentile Ranks Ease of obtaining test results (60.0%) CP instructions for follow-up care (80.0%) CP information about medications (73.5%) CP efforts to include in decisions (73.3%) CP concern for prob/condition (84.2%) Access to care (46.5%) Overall Patient Satisfaction Perception (53.0%) Post AIDET Pre AIDET 0 10 20 30 40 50 60 70 80 90 100 Percentile Rank Source: Oklahoma University; OUP Hematology/Oncology Clinic & Infusion Center; 10 providers & 22 staff, take care of 15,000 clinic visits & 10,000 chemotherapy infusions per year
Studer Group Five Fundamentals AIDET SM Focus on the A & I to show courtesy and respect by all physicians, nurses and staff. Focus on the E to explain medications and diagnosis. A I D E T Acknowledge Introduce Duration Explanation Thank You
Post Visit Calls: Clinical Quality Source: New Jersey Hospital, Total beds = 775; 3Q2007 4Q2010
Post-Visit Phone Call Sample Empathy and Concern Clinical Outcomes Reward and Recognition Service Process Improvement Appreciation Mrs. Smith? Hello. This is <name>. You were discharged from my unit yesterday. I just wanted to call and see how you re doing today Do you have any questions regarding your medications or any possible side effects? Have you filled your prescription yet? How is your pain now compared to when you were in the hospital? We want to make sure we do excellent clinical follow-up to ensure your best possible recovery. Do you know what symptoms or health problems to look out for? Do you have your follow-up appointment?... Mrs. Smith, we like to recognize our employees. Who did an excellent job for you while you were in the hospital?... Can you tell me why Sue was excellent?... We want to make sure you received excellent care. How were we, Mrs. Smith?... We re always looking to get better. Do you have any suggestions for what we could do to be even better?... (could add in questions regarding quality indicators such as hand washing, ID band check, etc.) We appreciate you taking the time this afternoon to speak with us about your follow up care. Is there anything else I can do for you?...
Always bring it back to values... Quint Studer
Healthcare Flywheel Prescriptive To Do s Purpose, worthwhile work and making a difference Bottom Line Results (Transparency and Accountability) WHY Self- Motivation
The HCAHPS Handbook Hardwire Your Hospital for Pay-for-Performance Success This book shares the essential tactics proven to dramatically improve, and sustain, HCAHPS results and position your hospital to maximize reimbursement. www.studergroup.com/hcahps
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